Long-term durability of response to adalimumab in Crohn's disease

BACKGROUND

Adalimumab is an effective treatment for Crohn's disease (CD), but may also be associated with loss of response. Few reports provide insight into the durability of treatment of CD with adalimumab for periods longer than 12 months in clinical practice.

AIMS

To evaluate the long-term durability of adalimumab maintenance treatment and to identify predictive factors associated with loss of response.

METHODS

CD patients who initially responded to adalimumab were evaluated in a historical cohort study. Maintenance of long-term response was estimated using Kaplan-Meier analysis. Cox regression analysis was performed to identify potential predictive factors for loss of efficacy.

RESULTS

In all, 380 CD patients were included (mean age, 38 years; 52% female). Of these, 43% had ileocolic CD, 50% inflammatory CD, and 41% perianal CD. Median follow-up with adalimumab was 8 months (range, 4-75 months). The annual risk of loss of response to adalimumab was 18% per patient-year of follow-up. Twenty-eight percent of patients were anti-TNF-naïve and 72% anti-TNF-experienced. The loss of efficacy was 8% per patient-year of follow-up in the anti-TNF-naïve patients and 22% in the anti-TNF-experienced group (P < 0.01). In the multivariate analysis, the presence of extraintestinal manifestations (hazard ratio [HR] = 1.7; 95% confidence interval [CI] = 1.02-2.9) and previous experience with other anti-TNF agents (HR = 2.5,95% CI = 1.2-5.3) were associated with higher risk of loss of efficacy.

CONCLUSIONS

A relevant proportion of CD patients on long-term adalimumab lost response. The risk of loss of response was higher (more than 2-fold) in anti-TNF-experienced than in anti-TNF-naïve patients (22% vs. 8% per patient-year of treatment). Having extraintestinal manifestations seems to increase the risk of loss of efficacy.

Optimizing the electrode size and arrangement in a microbial electrolysis cell

This study investigates the influence of anode and cathode size and arrangement on hydrogen production in a membrane-less flat-plate microbial electrolysis cell (MEC). Protein measurements were used to evaluate microbial density in the carbon felt anode. The protein concentration was observed to significantly decrease with the increase in distance from the anode-cathode interface. Cathode placement on both sides of the carbon felt anode was found to increase the current, but also led to increased losses of hydrogen to hydrogenotrophic activity leading to methane production. Overall, the best performance was obtained in the flat-plate MEC with a two-layer 10 mm thick carbon felt anode and a single gas-diffusion cathode sandwiched between the anode and the hydrogen collection compartments.

Clinical and microbiological efficacy of an antimicrobial mouth rinse containing 0.05% cetylpyridinium chloride in patients with gingivitis

OBJECTIVES

the aim of this study was to evaluate the effects of the use of a mouth rinse and dentifrice with cetylpyridinium chloride (CPC) in patients with gingivitis.

METHODS

the study was designed as a 1-month, double-blind, parallel, randomized clinical trial comparing a negative control regimen (minus active ingredients dentifrice and mouth rinse) with the test products (dentifrice and mouth rinse with 0.05% CPC) in terms of plaque and gingival indexes (PI, GI), patient-based and microbiological outcome variables. The comparisons in relation to the main outcome variables (PI and GI) were made by means of the t-test, either unpaired or paired for the intergroup and intragroup comparisons, respectively.

RESULTS

no differences were detected at baseline. Both groups showed statistically significant decreases in GI (0.17-0.19), without intergroup differences. The PI demonstrated a significant decrease of -0.12 in the test group and minor changes in the negative control group (increase of +0.01). Differences between groups showed a tendency towards statistical significance. A limited impact was observed for microbiological variables in both groups.

CONCLUSION

the results of this study show limited benefits of the evaluated formulations as adjuncts to unsupervised oral hygiene in reducing plaque accumulation, and no effect on gingivitis.

Electrocoagulation of wastewater from almond industry

This work was carried out to study the treatment of almond industry wastewater by the electrocoagulation process. First of all, laboratory scale experiments were conducted in order to determine the effects of relevant wastewater characteristics such as conductivity and pH, as well as the process variables such as anode material, current density and operating time on the removal efficiencies of the total organic carbon (TOC) and the most representative analytical parameters. Next, the wastewater treatment process was scaled up to pre-industrial size using the best experimental conditions and parameters obtained at laboratory scale. Finally, economic parameters such as chemicals, energy consumption and sludge generation have been discussed.

Effect of silymarin on kidneys of rats suffering from alloxan-induced diabetes mellitus

Oxidative stress contributes to the pathogenesis of diabetes mellitus and its sequelae nephropathy. The kidneys are especially prone to damage by free radicals. We therefore tested the effect of the flavonoid mixture silymarin, a free radical scavenger, on the activity and gene expression of superoxide dismutase, glutathione peroxidase and catalase, as well as on renal tissue morphology in rats with alloxan-induced diabetes mellitus. Alloxan-intoxicated rats were treated with silymarin 20 days after alloxan administration for 9 weeks. Alloxan-induced tissue damage and decreased the activity of the three enzymes, SOD (U/mg prot.): 14.4±1.75 vs 112±6.45 control, p<0.05, n=6; GSHPx (μM NADPH/min/mg prot.): 0.02±0.002 vs 0.121±0.01 control, p<0.05, n=6; CAT (k/seg/mg prot.): 0.022±0.003 vs 0.044±0.002 control, p<0.05, n=6. Silymarin treatment prevented tissue damage and restored the activity (SOD: 110.7±12.9U/mg prot.; GSHPx: 0.329±0.031 μM NADPH/min/mg prot.; CAT: 0.054±0.002 k/seg/mg prot., n=6) and gene expression of the three antioxidant enzymes after 20 days of alloxan administration (SOD: 12.00±0.57 control, 9.00±0.1 diabetic p<0.05, 11.00±0.20 silymarin treated; GSHPx: 6.01±0.78 control, 9.03±0.3 diabetic p<0.05, 7.02±0.07 silymarin treated; CAT: 9.03±1.07 control, 12.02±0.60 diabetic p<0.05, 8.06±0.31 silymarin treated, n=6). It is suggested in this study that recuperative effect of silymarin on the renal tissue damage induced by alloxan may be related to an increase in the activity and recovery of gene expression of antioxidant enzymes which in addition to the glutathione system constitute some of the most important defense mechanisms against free radicals damage. As these results show, silymarin may be considered potentially in the treatment of diabetic nephropathy.

Effects of using mixed wine yeast cultures in the production of Chardonnay wines

The effect of using mixed cultures of non-Saccharomyces and Saccharomyces cerevisiae yeasts in the physicochemical and sensory qualities of the wines were analyzed in this study. Based on growth curves, sugar consumption and glycerol production in synthetic must, Candida membranifaciens L1805 was selected from a group of four Candidas spp. isolates from Chile and Argentina. This yeast was subsequently used in combination with S. cerevisiae in Chardonnay must. A monoculture of S. cerevisiae was used as control. The wines fermented with mixed cultures had lower volatile acidity and ethanol concentration than the control. Furthermore, the chromatographic analysis showed that the wines from mixed cultures presented differences in the concentration of esters and propanol. These characteristics positively influenced the sensory qualities of the wines produced with mixed cultures, which was reflected in the preference for these wines by a panel of enologists. This study shows that the use of non-Saccharomyces yeasts could be a strategy to obtain distinctive wines using the native microorganisms from each winemaking area.

Vesicle-related microRNAs in plasma of nonsmall cell lung cancer patients and correlation with survival

The identification of tumour biomarkers that detect the presence of disease using noninvasive diagnostic procedures is a key part of cancer research. We determined in plasma the vesicle-related microRNA (miRNA) expression profile of nonsmall cell lung cancer (NSCLC) and evaluate whether plasma miRNAs can be both discriminating (between patients and healthy controls) and prognostic markers. 365 human miRNAs were analysed by Taqman® low-density arrays (Applied Biosystems, Foster City, CA, USA) in the plasma from 28 NSCLC patients and 20 controls. Five selected miRNAs (let-7f, miR-20b, miR-30e-3p, miR-223 and miR-301) were validated independently by real-time PCR in plasma from 78 NSCLC and 48 controls and correlated with pathologic parameters and survival. Levels of let-7f, miR-20b and miR-30e-3p were decreased in plasma vesicles of NSCLC patients. Moreover, levels of let-7f and miR-30e-3p distinguished between two groups of patients for stage of disease and therefore possibility of surgery. Plasma levels of miR-30e-3p and let-7f were associated with short disease-free survival and overall survival, respectively. NSCLC patients and healthy controls differ in vesicle-related miRNAs in plasma. Levels of let-7f and miR-30e-3p in NSCLC patients are associated with poor outcome. Thus, plasma vesicle-related miRNAs obtained by noninvasive methods could serve as circulating tumour biomarkers of discriminating and prognostic value.

In vitro engineering of complete autologous oral mucosa equivalents: characterization of a novel scaffold

BACKGROUND AND OBJECTIVE

Restoration of oral mucosa defects by means of in vitro-cultured equivalents has become a valid alternative in the field of oral and periodontics surgery. Although different techniques have been described, none has been able to provide an equivalent with an autologous scaffold for the epithelium. The purpose of this study was to obtain complete autologous oral mucosa equivalents (CAOME) using the patient's own fibroblasts and plasma and to characterize these equivalents both morphologically and immunohistochemically.

MATERIAL AND METHODS

We acquired cell types (keratinocytes and fibroblasts) from the same mucosal samples, which were taken from healthy patients who underwent oral surgery. To construct the CAOME, a small sample of blood was obtained from the patient and subsequently processed to obtain a fibrin glue scaffold. All CAOME thus obtained were stained using the standard hematoxylin and eosin method to study their morphological characteristics. To establish the type of cells in the epithelial layer, CAOME were stained with pancytokeratin AE1/AE3, cytokeratins 5/6 and 13, p-63 and Ki-67. Finally, laminin 5 and collagen IV were used to reveal the presence of a basal membrane.

RESULTS

The CAOME featured a monolayer of cube-shaped epithelial cells similar to that found on the basal layer of the oral mucosa. Close to the epithelial layer lay the fibrin and fibroblasts-embedded scaffold. The CAOME was positive to pancytokeratin AE1/AE3, cytokeratin 5/6 and p-63. No reaction was found to cytokeratin 13 and Ki-67. There was staining to laminin 5 but not to collagen IV.

CONCLUSIONS

It is possible to engineer a CAOME with an epithelium of basal-like and immature keratinocytes, which could potentially reconstruct in vivo loss of tissue.

Antibacterial and antitumorigenic properties of microcin E492, a pore-forming bacteriocin

Microcins are a family of low-molecular weight bacteriocins produced and secreted by Gram-negative bacteria. This review is focused on microcin E492, a pore-forming bacteriocin produced by Klebsiella pneumoniae RYC492 that exerts its antibacterial action on related strains. The steps necessary for the production of active microcin E492 involve post-translational modification with a catechol-type siderophore at the C-terminal and proteolytic processing during export to the extracellular space. This bacteriocin has a modular structure, with a toxic domain at the N-terminal and an uptake domain at the C-terminal of the mature protein. The mechanism by which the C-terminal of microcin E492 is recognized by catecholate siderophore receptors is called the "Trojan horse" strategy, because the C-terminal structure mimics essential bacterial elements, which are recognized by the respective receptors and translocated across the outer membrane to exert antibacterial action. The C-terminal uptake module can be exchanged and used with other toxic domains. Microcin E492 also has a cytotoxic effect on malignant human cell lines. The cytotoxic mechanism is through apoptosis, a desired mechanism for cancer therapy. The ability of microcin E492 to form amyloid-like fibrils constitutes a property that can be exploited in the formulation of this bacteriocin as an antitumoral agent, because these fibrils can behave as stable depots to ensure the sustained release of a biologically active molecule. Alternatively, live bacteria can be used as a continuous source of microcin E492 production in specific tumors.

[Description of registration of episodes of gender violence in medical records in the Principality of Asturias, Spain]

OBJECTIVE

To describe how episodes of gender violence notified to the Registro de Atención Sanitaria en Violencia contra las Mujeres del Principado de Asturias (VIMPA) are registered in the clinical records of a health area of this geographical region.

METHODS

We performed a cross-sectional, descriptive study in a sample of cases collected in the VIMPA Registry in 2005 and 2006. The variables analyzed were the way in which the episode of gender violence was coded and registered, the presence of antecedents, and the diagnostic agreement among documents.

RESULTS

A total of 51.7% of primary care patients were attended in a center with access to their medical records. A specific International Classification of Primary Care-2 (World Organisation of National Colleges and Academics) code of abuse was used in only 15.1%, while a written diagnosis was used in all cases in specialized care.

CONCLUSION

Episodes of gender violences were identified differently in distinct clinical documents. Our results point to the need for specific registries that would aid the combined use of distinct information sources.

Development of a panel of well-characterized human immunodeficiency virus type 1 isolates from newly diagnosed patients including acute and recent infections

The aim of this study was the development of a panel constituted by well-defined HIV-1 strains of different genetic forms, with a particular focus on isolates from acute and recent infections. Fourteen HIV-1 isolates, including four from acute and five from recent infections, were expanded in peripheral blood mononuclear cells. SI phenotype, coreceptors use, and TCID(50)/ml were determined. V3 net charge was calculated. Near full-length genomes were amplified by RT-nested PCR in four overlapping segments. Phylogenetic analyses were performed with neighbor-joining trees and bootscanning. Analysis of cysteine residues, lengths of variable regions, and potential N-linked glycosylation sites in gp120 and gp41 was performed. Viral stocks were produced. Thirteen strains were NSI/R5 and one SI/R5,X4. TCID(50)/ml ranged between 10(4.6) and 10(6). V3 net charge was <+5 in 12 sequences and +5 in two sequences. Near full-length HIV-1 genomes analysis identified viruses of the following genetic forms: eight subtype B, three subtype C, two CRF02_AG, and one subtype G. Cysteine residues that form the V1,V2,V3, and V4 loops were highly conserved. The number of potential N-linked glycosylation sites in gp120 and gp41 ranged between 24-29 and 4-6, respectively. Seven potential N-linked glycosylation sites in gp120 and three in gp41 were conserved. V1, V2, V4, and V5 variable regions exhibited substantial length variation. In addition, an analysis of transmitted and natural resistance to current antiretroviral drugs in these strains was performed. It is worth mentioning that the 13S mutation in the V3 sequence, associated with resistance to maraviroc, was observed in a subtype B strain that harbored resistance mutations to nucleoside reverse transcriptase inhibitors and to T20. The availability of a panel including strains from acute and recent infections should be a valuable resource for optimizing and standardizing vaccine candidate assessment. Near full-length genome characterization may be necessary for evaluating clade-specific reactivities.

Characterization of the placental macrophage secretome: implications for antiviral activity

It is well documented that placental macrophages show lower levels of HIV-1 infection than monocyte-derived macrophages (MDM). We used proteomic methods to test the hypothesis that placental macrophages secrete different proteins as compared to MDM that may contribute to decreased HIV-1 replication. Placental macrophages and MDM were cultured for 12 days and supernatant was collected. To characterize supernatants, the protein profiles of placental macrophages and MDM were compared using the protein chip assay. Subsequently, proteins were separated by one-dimensional gel electrophoresis and identified by tandem mass spectrometry at the corresponding mass to charge (m/z) range of 5000-20,000. Significant differences were found between placental macrophages and MDM in seven protein peaks with m/z values of 6075, 6227, 11,662, 14,547, 6158, 7740, and 11,934 on the CM10 and IMAC chips. After sequencing and identification, five proteins were validated for differential expression in placental macrophages and MDM by Western blot analyses. Peroxiredoxin 5, found to be more abundant in placental macrophage supernatants, is important in the cellular antioxidant mechanisms, and other members of its family have shown antiviral activity. Cystatin B was less abundant in PM supernatant, and decreased intracellular levels have recently been shown to be associated with lower HIV-1 replication in placental macrophages than in MDM. This study elucidates for the first time the placental macrophage secretome corresponding to 5000-20,000 Da and advances our understanding of the proteins secreted in the placenta that can protect the fetus against HIV-1 and other viral infections.

[Negative results associated with medication in the emergency department of a hospital]

OBJECTIVE

To find out the prevalence of negative results associated with medication (herein referred to as NRM) in patients attending the emergency department. To classify the results by severity, avoidability and cost, as well as to establish the factors associated with their appearance.

METHOD

Observational, descriptive and cross-sectional study carried out in the emergency department of a tertiary hospital. Patient surveys and emergency department records were used as sources of information. The Dader Method and guidelines from the Third Consensus of Granada were used. Pearson's chi2 test was used to find the association between age, gender and number of drugs and showing signs of NRM. Avoidability was measured using Baena et al's criteria and severity was assessed according to whether or not the patient had been admitted into an observation stall or on to a hospital ward.

RESULTS

24.4% of patients visited the emergency department because of NRM. 16.1% needed to be hospitalised to solve their health issue. 83.9% of all patients with NRM and 77.3% of those hospitalised due to NRM could have been avoided. Statistically, there was a higher prevalence of NRM in patients taking 5 or more different drugs. An estimated euro 14,666,178 was spent on treating avoidable NRM cases in 2003.

CONCLUSIONS

The prevalence of NRM in those who attended the emergency department, the high percentage of avoidability and the cost imposed on the Health Service seem to sufficiently argue a case for the consideration that NRM as a problem which requires the implementation of prevention programmes based on drug-treatment monitoring.

[Influence of neostigmine on the course of neuromuscular blockade with rocuronium or cisatracurium: a randomized, double-blind trial]

OBJECTIVES

To compare the time-course of neuromuscular blockade with rocuronium or cisatracurium during intravenous anesthesia, in terms of both the time to spontaneous recovery or time to reversal after administration of neostigmine.

MATERIAL AND METHODS

Patients classified as ASA 1-2 were randomized to receive blinded administration of a single injection of twice the 95% effective dose of rocuronium or cisatracurium for general anesthesia, and then neostigmine plus atropine at recovery of the first train-of-4 (TOF) twitch at 5% or 25%, or normal saline solution as placebo at recovery of the first TOF twitch at 25%. The neuromuscular blockade was monitored by acceleromyography. Intergroup comparisons were carried out by Student t test and analysis of variance.

RESULTS

Sixty patients were enrolled. Mean (SD) time to onset was faster with rocuronium at (1.04 [0.32] minutes) compared with cisatracurium at (2.58 [0.81] minutes) and duration was shorter: time to the first twich at 5% was 30 (6.4) minutes with rocuronium and 38.1 (9.7) minutes with cisatracurium. The total duration of blockade (time to the 80% TOF ratio) was also shorter with rocuronium when the neuromuscular blockade was reversed, but there were no differences in the time to block reversal when neostigmine was not used: 62 (18.9) minutes to recovery from the rocuronium blockade vs 66.96 (15.9) minutes to recover from a cisatracurium blockade. A high percentage of patients had less than an 80% TOF ratio at 60 and 90 minutes of administration of the neuromuscular blockerswhen reversal was not used (patients receiving rocuronium, 60% at 60 minutes, and 20% at 90 minutes; patients receiving cisatracurium, 80% at 60 minutes, and 40% at 90 minutes).

CONCLUSION

Not antagonizing a rocuronium- or cisatracurium-induced neuromuscular blockade in surgical procedures lasting less than 90 minutes can lead to a high percentaje of residual blockade (TOF ratio <80%).

Effect of formic acid on performance, digestibility, intestinal histomorphology and plasma metabolite levels of broiler chickens

1. The effect of dietary formic acid on performance, digestibility, intestinal histomorphology and plasma metabolite levels of broiler chickens was studied. 2. An experiment with 120 Ross male broiler chickens was conducted from 1 to 42 d of age at the laboratory. There were 4 treatment groups: control (C), 10 mg/kg feed avilamycin (AV) and formic acid at two concentrations, 5 and 10 g/kg feed (FA5 and FA10, respectively). 3. No differences in weight gain, feed intake or feed conversion ratio were observed in male broiler chickens fed on the different diets. 4. An effect of the additives on ileal dry matter (DM) digestibility at 42 d of age was detected with the finisher diets; AV and 10 g/kg of feed formic acid slightly improved ileal DM digestibility compared to the other treatment groups. 5. Jejunum pH was not affected when 5 or 10 g/kg formic acid was added, and the results do not clearly show a positive effect of formic acid on the intestinal histomorphology. 6. No differences were noticed for blood metabolites in the different diets, and the levels of calcium and phosphorus in the plasma were not altered by formic acid addition. 7. In conclusion, when using broiler chickens under conditions of good hygiene, dietary formic acid did not have a clear positive effect on performance, intestinal histomorphology or plasma metabolite levels; however, there was a slight positive effect on the ileal digestibility of nutrients.

The presence of an intronic deletion in p73 and high levels of ZEB1 alter the TAp73/DeltaTAp73 ratio in colorectal carcinomas

TAp73 variants largely mimic p53 suppressor activities, while DeltaTAp73 forms act as oncogenes through the inactivation of p53 and TAp73. The present study analysed how TAp73 and DeltaTAp73 levels might be affected by the presence of a 73 bp deletion in a regulatory region of p73. The clinical relevance of this deletion was also examined. ZEB1 can bind to the region repressing p73 transcription in vitro. The relationship between ZEB1 and p73 variant expression levels was studied in the context of this deletion and the levels of the ZEB1 cofactors p300 and CtBP. Tumour and normal tissue from 81 colorectal cancer patients was analysed to evaluate firstly the levels of TAp73, DeltaTAp73 (DeltaEx2p73, DeltaEx2/3p73, and DeltaNp73), ZEB1, p300, and CtBP by quantitative real-time RT-PCR, and secondly the presence of the 73 bp deletion. Tumour characteristics were examined in each patient. Suppressor and oncogenic isoforms of p73 were co-up-regulated in tumour tissues. Overexpression of p73 variants was associated with adverse tumour features. The 73 bp deletion was present in 40% of the patients and was associated with adverse pathological parameters of the tumours and also with TAp73 down-regulation. In those cases harbouring the deletion, the levels of ZEB1 and those of DeltaEx2p73, DeltaEx2/3p73, and DeltaNp73 correlated directly. Variations in the concentration of p300 affected the observed correlations between ZEB1 and the different p73 variants. In conclusion, in colorectal cancer, the 73 bp deletion in the first intron of the p73 gene and different expression levels of ZEB1 and p300 may act in concert to affect the ratio of TAp73/DeltaTAp73 forms, favouring p73 oncogenic variants. In addition, up-regulation of p73 oncogenic isoforms predicts a poor prognosis based on its relationship with advanced tumour stage.

Response of Broilers to Feeding Low-Calcium and Phosphorus Diets Plus Phytase Under Different Environmental Conditions: Body Weight and Tibiotarsus Mineralization

Three experiments on Ross broiler chickens were conducted in 3 locations: cages (Experiment 1), floor pens (Experiment 2), and commercial farms (Experiment 3). The effect of low-total P (TP) wheat-soybean based diets plus microbial phytase (Natuphos) was evaluated. Four experimental starter and finisher diets were used in a 2-phase feeding program, as follows: control diet (SC until 21 d, FC from 22 to 42 d); 2 diets (SL400 and SL600 until 21 d, FL400 and FL600 from 22 to 42 d) with low TP (0.61% for starter and 0.54% for finisher), including 400 and 600 U/kg of phytase, respectively; and a very low-TP (0.52% for starter and 0.44% for finisher) diet (SVL600 until 21 d, FVL600 from 22 to 42 d) with 600 U/kg of phytase. In Experiment 1 (broilers in cages had movement limitation and no access to litter), no differences in BW, tibiotarsus mineralization, or mineral metabolism were observed among diets. In Experiment 2 (broilers in floor pens had movement limitation and access to litter), at 21 d of age, the lowest tibiotarsus ash percentage and BW were shown by birds fed the SVL600 diet. At 42 d of age, broilers fed the FC diet were the lightest. For the rest of the parameters of tibiotarsus mineralization and mineral metabolism measured in Experiment 2, no differences were shown. In Experiment 3 (broilers in commercial farms had access to litter without movement limitation), the BW of broilers fed the SC diet was the highest at 21 d of age. At 42 d of age, the broilers fed FL400 and FL600 diets were the heaviest. At the end of Experiment 3, broilers fed the FC diet had the highest dry litter Ca and P, whereas broilers fed the FVL600 diet had the lowest values. In conclusion, the very low-TP wheat-soybean based diet supplemented with 600 U/kg of phytase was sufficient to optimize all the parameters measured in Experiment 1 but not in Experiments 2 and 3. Therefore, when evaluating Ca and P in phytase-supplemented diets for broilers, it is necessary to bear in mind the environmental conditions of experimentation.

[Clinical effect of mivacurium in morbidly obese patients]

OBJECTIVES

To compare the clinical effect of mivacurium in morbidly obese and normal-weight patients.

PATIENTS AND METHODS

Ten morbidly obese patients (body mass index >40) and 10 normal-weight patients (body mass index, 21-24) with normal plasma cholinesterase levels. Anesthesia was provided with propofol and remifentanil in continuous infusion and a mixture of oxygen and nitrous oxide. Mivacurium was administered at a dose based on the patient's weight (0.15 mg x kg(-1)). The neuromuscular block was monitored by train-of-four (TOF) acceleromyography after stimulation of the cubital nerve at the forearm. We measured the onset time (time from administration of the muscle relaxant to 95% twitch depression), duration of block (times from dosing to 5% recovery after the first twitch [T1] of a TOF stimulus and to a TOF ratio of 80%), and the recovery indices (time between 25% and 75% recovery after T1 and between recovery of TOF ratios of 25% and 80%). Groups were compared with the Student t test.

RESULTS

Mean (SD) onset time was similar in the 2 groups (normal weight 2.73 [1] minutes vs morbidly obese 1.91 [0.6] minutes). Other measures of duration and recovery were also similar in the 2 groups, respectively: duration of dose-T1 5%, 12.23 (2.1) vs 11.45 (3) minutes; dose-TOF ratio 80%, 24.71 (4.6) vs 24.81 (5) minutes); recovery index T1 25%-75%, 6.45 (2) vs 5.56 (1) minutes; recovery of TOF ratio T1 25%-80%, 9 (2) vs 10.11 (2) minutes.

CONCLUSION

We found no differences in the clinical effect of mivacurium between morbidly obese and normal-weight patients when doses were based on real weight.

Epidemiological, biological and histological characterization of patients with indeterminate third-generation recombinant immunoblot assay antibody results for hepatitis C virus

We studied the epidemiological, laboratory and histological characteristics of a group of patients with positive antibodies against hepatitis C virus (HCV) as determined by third-generation enzyme-linked immunosorbent assay (ELISA), and with indeterminate HCV antibody positivity as established by third-generation recombinant immunoblot assay (RIBA-3). The results obtained were compared with those recorded in a group of RIBA-3-positive patients. Both groups correspond to blood donors in whom the prevalence of hepatitis C is low. There were no statistically significant intergroup differences in mean age, or in the presence of infection risk factors. RNA positivity was much more frequent in the RIBA-positive group (71%vs 10%; P < 0.05), as was transaminase elevation during the 3 years of follow-up (54%vs 13%; P < 0.05). In 46% of the RIBA-indeterminate patients the liver biopsy proved normal, or only liver steatosis or minimal changes were detected, while 33% had persistent chronic hepatitis, and 21% showed active chronic hepatitis. A mean Knodell index score of 2.28 was recorded; 50% of the subjects showed no fibrosis, 46% grade 1 fibrosis (fibrous portal expansion), 4% grade 2 fibrosis (bridging fibrosis), and none grade 3 fibrosis (liver cirrhosis). In the RIBA-positive group, a greater percentage of patients had active chronic hepatitis, a greater Knodell index, and increased-grade fibrosis. It can be concluded that the RIBA-3-indeterminate group is epidemiologically similar to the RIBA-3-positive series, although with a lesser prevalence of laboratory test alterations, a lower viral replication index, and more likely to have benign disease - particularly in subjects without viral replication.

Pneumatosis cystoides intestinalis in a rabbit doe (Oryctolagus cuniculus)

Pneumatosis cystoides intestinalis (PCI) is an infrequent condition of animals characterized by the existence of numerous thin-walled, gas-filled cystic structures within the intestinal wall and adjacent lymph nodes. Microscopically, the cystic structures appear to be dilated lymphatics located in the lamina propria, submucosa, muscularis, subserosa, mesentery, and mesenteric lymph nodes. This report describes a case of pneumatosis cystoides intestinalis in a rabbit doe from an organic farm where 20 rabbit does were fed ad libitum with a natural diet consisting of whole barley, pea beans, alfalfa hay, and a pelleted vitamin-mineral blend. A combination of nutritional, bacterial, and other factors are hypothesized as possible predisposing factors in the development of PCI.

Time course and train-of-four fade of mivacurium block during sevoflurane and intravenous anaesthesia

BACKGROUND AND OBJECTIVE

Volatile anaesthetics inhibit nicotinic acetylcholine receptors at clinically relevant concentrations with higher affinity for the neuronal nicotinic receptor. The inhibitory effects of propofol on nicotinic receptors have only been documented at supraclinical concentrations. The aim of this study was to determine recovery properties and train-of-four (TOF) fade of mivacurium during sevoflurane and propofol anaesthesia, in order to examine any differences both in the enhancement of the neuromuscular block (postjunctional effects) and in TOF fade (prejunctional effects).

METHODS

Twenty ASA I-II adult patients were randomly allocated to maintenance of anaesthesia with sevoflurane (end-tidal concentration 2%) or propofol. Neuromuscular block was assessed by acceleromyography and a single dose of mivacurium (0.15 mg kg(-1)) was administered (in the sevoflurane group after 30 min of exposure to sevoflurane). We measured time for recovery of the first twitch of the TOF (T1) from 25-75%, time from 25% recovery of T1 to achieving a TOF ratio (TOFR) of 0.8, TOFR at 50%, 75% and 90% recovery of T1, and height of T1 at TOFR of 0.7 and 0.9. Data were tested using t-test for independent samples.

RESULTS

Recovery times (mean (95% confidence interval, CI)) of mivacurium in the sevoflurane group (T1 25-75%, 11.3 (8.1-14.5) min; T1 25%-TOFR0.8, 19.1 (15.7-22.5) min) were significantly longer (P < 0.05) than in the propofol group (T1 25-75%, 6.5 (5.2-7.7) min; T1 25%-TOFR0.8, 11.3 (7.8-10.3) min). No differences were found in the relations between TOFR and T1 or vice versa, between the groups.

CONCLUSIONS

Recovery times after a single dose of mivacurium were prolonged by sevoflurane compared with propofol but no differences in TOF fade were observed between the two anaesthetics.

Influence of two plant extracts on broilers performance, digestibility, and digestive organ size

A 42-d trial was conducted to study the influence of 2 plant extracts on performance, digestibility, and digestive organ weights in broilers. The feeding program consisted of a starter diet until 21 d and a finisher diet until 42 d. There were 4 treatment groups: control; 10 ppm avilamycin (AB); 200 ppm essential oil extract (EOE) from oregano, cinnamon, and pepper; and 5,000 ppm Labiatae extract (LE) from sage, thyme, and rosemary. No differences in feed intake or feed conversion were observed. From 14 to 21 d of age, broilers fed the LE diet grew faster than the broilers fed the control or EOE feeds (68.8 vs. 63.9 and 61.6 g/d, respectively). Antibiotic and plant extract supplementation improved apparent whole-tract and ileal digestibility of the nutrients. For starter feed, LE supplementation improved apparent fecal digestibility of DM (P < 0.01), and all additives increased ether extract digestibility (P < 0.001). However, no effect was detected for CP digestibility (P > 0.1). At the ileal level, the AB, EOE, and LE supplementation of the starter feed increased DM and starch (P < 0.01) digestibility but not CP digestibility (P > 0.1). All additives improved apparent fecal digestibility of DM and CP of the finisher diet. No differences were observed for proventriculus, gizzard, liver, pancreas, or large or small intestine weight. In the present study, both plant extracts improved the digestibility of the feeds for broilers. The effect of different additives on digestibility improved the performance slightly, but this effect was not statistically significant.

[Performance analysis of a new anesthetic system: the Temel Supra--part I]

OBJECTIVES

To evaluate the performance of a new anesthetic system that purports to provide novel advantages in ventilating the anesthetized patient.

MATERIAL AND METHODS

A performance analysis was carried out in our respirator function laboratory using lung simulators to assess the system, its degree of compliance with current regulations, and the degree of compliance with the manufacturer's claims.

RESULTS

The system is 100% effective. The internal compliance of the respirator was 0.13 +/- 0.01 mL/cm H2O, inspiratory resistance was 1.9 +/- 0.1 cm H2O/L/s, expiratory resistance was 3.1 +/- 0.3 cm H2O/L/s, and internal volume was 130 mL.

CONCLUSIONS

The Temel Supra device is versatile and meets the anesthetic requirements of patients undergoing any type of surgery. The possibility of using an open circuit, a low flow, a closed circuit, or a continuous flow without having to change to another system allows the anesthesiologist to make use of the advantages of each circuit without its drawbacks. The efficacy of the circuit is 100%. The low internal volume means that internal compliance is negligible and time constants are low, guaranteeing that the volume programmed is the same as the volume delivered and facilitating alveolar redistribution of gases. The monitoring and warning systems assure safe patient ventilation and accurate dosing of gases and anesthetic agents.

[Acute lung injury related to transfusion of fresh frozen plasma]

A 23-year-old woman with no relevant medical history required transfusion of 2 units of fresh frozen plasma before diagnostic laparoscopy. Following transfusion, serious bilateral pulmonary edema with hypoxia developed and resolved with 48 hours of mechanical ventilation. Immunological testing of blood from the 2 donors and the patient revealed the presence of anti-HLA DR-52 antibodies in the plasma of a donor and the presence of the corresponding antigen in the patient, confirming the diagnosis of fresh frozen plasma transfusion-related acute lung injury. Transfusion-related acute lung injury associated with plasma-containing blood products has an incidence of 1:5000 transfused units and a mortality rate of up to 10% of cases. Clinical suspicion should remain high in making the diagnosis and ruling out other causes of pulmonary edema, given that a firm diagnosis will come only after immunological testing. Transfusion-related acute lung injury is considered an under-diagnosed syndrome and must be included in the differential diagnosis of respiratory distress when a transfusion has been given.

Psychology over the Internet: On-Line Experiences

The "International Symposium on Psychology over the Internet: On-Line Experiences" was held in Lima, Peru, July 2003, at the 29th InterAmerican Congress of Psychology. The main topic was the advantages and disadvantages of using this technology in the applied field of psychology. The Internet has been considered a new alternative for teaching-learning processes (virtual classroom); vocational assessment; counseling and orientation (virtual psychological consultation); and intervention focused on specific health-related problems. These experiences of on-line psychological services and their conclusions are briefly described herein.

Stir bar sorptive extraction and large volume injection gas chromatography to determine a group of endocrine disrupters in water samples

Stir bar sorptive extraction (SBSE) combined with gas chromatography (GC) with mass spectrometric detection (MS) has been applied to determine a group of suspected endocrine disrupters in water samples. One centimeter stir bars coated with PDMS were used to extract the analytes and then solvent desorption was carried out. The absorption and desorption parameters in SBSE were optimized and large volume injection was used with a programmed temperature vaporizer injector (PTV) in GC to enhance the sensitivity of the method. The linear range of some endocrine disrupters was between 0.05 and 5 microg l(-1) and limits of detection were 0.01-0.24 microg l(-1) under full scan acquisition mode. The repeatability and reproducibility of the method (n = 5) for Ebro river water samples spiked at a level of 0.5 microg l(-1) was below 13 and 23%, respectively. Recoveries between 42 and 96% were obtained with the exception of atrazine. The method was applied to analyze real water samples from the Ebro River and irrigation streams of Ebro Delta and some of the compounds studied (aldrin, dieldrin, 4,4'-DDE and 4,4'-DDT) were found in some of them between detection and quantification limits.

[Effect of sevoflurane on the neuromuscular blockade produced by continuous mivacurium infusion ]

OBJECTIVE

To evaluate the effect of sevoflurane on a neuromuscular block from mivacurium in continuous infusion.

PATIENTS AND METHODS

Fourteen ASA I-II patients receiving general anesthesia for orthopedic procedures on the knee. The neuromuscular block was monitored by acceleromyography in the adductor pollicis muscle after stimulation of the cubital nerve. Anaesthesia was induced with propofol and remifentanil. After orotracheal intubation, mivacurium was given in continuous infusion adjusted to obtain a stable submaximal block defined as a variation in the block of 3% more or less for 10 minutes (first response on a train of four [T1] between 40% and 60% of the calibrated value). Values for T1, the T4/T1 ratio (TR) and temperature over the thenar eminence were recorded at 3 moments: control moment (infusion of mivacurium and sevoflurane at an expired fraction of 1.5% for 30 minutes) and post-sevoflurane moment (perfusion of mivacurium and sevoflurane at an expired fraction of 0% for 15 minutes). Statistical analysis was by analysis of variance and post-hoc contrast (Tukey).

RESULTS

Results are expressed as means with standard error between parentheses. We found that values at T1(%) and TR(%) were significantly lower at the sevoflurane moments (T1 = 43.11 [1]; TR = 25.68 [1]) and the post-sevoflurane moment (T1 = 36.29 [2]; TR = 25.06 [2]) than at the control moment (T1 = 53.18 [1]; TR = 38.93 [1]) (P < .05). T1 was significantly lower at the post-sevoflurane moment than at the sevoflurane moment (P < .05) but TR did not differ significantly.

CONCLUSION

Sevoflurane causes a significant increase in the neuromuscular block maintained by mivacurium in continuous infusion and the increase lasts at least 15 minutes after the halogenated agent is cleared from blood.

Intracellular expression of CD69 in endometrial and peripheral T cells represents a useful marker in women with recurrent miscarriage: modulation after allogeneic leukocyte immunotherapy

PROBLEM

To characterize in fertile women and women with recurrent spontaneous abortions (RSA) the expression and functional status of T cells expressing the CD69 molecule.

METHOD OF STUDY

We analyzed by flow cytometry in peripheral blood and endometrium from fertile and RSA women, the surface and cytoplasmic expression of CD69 on gated T cells. In addition, we investigated by three-color flow cytometry the expression of cytokines, and subsets of memory T cells.

RESULTS

In T cells, CD69 was restricted to the intracellular compartment with a higher frequency in RSA than in fertile women (68.2 +/- 12% versus 23.7 +/- 22%, P < 0.001, and 20 +/- 9.5% versus 2.1 +/- 3.8%, P < 0.005, in endometrium and peripheral blood, respectively). In contrast, the number of interferon-gamma+ (IFN-gamma+) secreting cells was higher (16 +/- 5% versus 6 +/- 1%) in fertile women. All 11 RSA women alloimmunized with parental leukocytes reached values of CD3 +/- CD69+ cells similar to those observed in fertile women.

CONCLUSIONS

CD69 might represent a useful marker in the diagnosis and the follow up of RSA patients.

Is decreased HIV-1 infectivity of placental macrophages caused by high levels of beta-chemokines?

The objective of this study was to determine the effect of beta-chemokine secretion on HIV infection of placental macrophages (HF) as compared to monocyte-derived macrophages (MDM). For this purpose, we measured chemokine production in supematants of LPS stimulated and unstimulated HF and MDM. LPS stimulated cultures produced 3 to 10 times higher levels of MIP-1alpha, MIP-1beta and RANTES than unstimulated cultures. The level of MIP-1beta was the highest of the three chemokines secreted upon stimulation of HF cells. Cell cultures were inoculated with HIV-BaL, a R5 virus, and tested for p24 antigen and chemokine production at days 5 and 10 post-infection (P.I.). We did not find significant differences in the level of chemokines produced by HIV-1-infected and uninfected MDM and HF cells. However, significant differences were found in p24 antigen released by unstimulated and LPS stimulated cells. In contrast to HF cells, MDM cultures showed a significant inhibition of p24 antigen production when cells were stimulated with LPS prior to infection. HF cells were less susceptible to HIV-1 infection than MDM, and chemokines produced by HF cells did not result in further inhibition of HIV-1 infection. We found that in contrast to MDM, decreased susceptibility HF cells to HIV infection is not due to increased levels of chemokines, but to decreased HIV-1 coreceptor expression.